health and human services: 2007 afi data report guide

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2007 AFI IDA Data Report Pre-population & Required Fields Guide

Please use this document as you complete the online form for the 2007 Data Report. Remember, the DataReport Help Desk is available to answer additional questions. You can reach them at 1-866-778-6037or by emailing [email protected] .

For All Grantees:

“Required” heading – Indicates whether the answer is required. The online system will not allow you to “complete” thesection without providing an answer for each required item.

“Question / Data Description” – Questions to answer or data to provide.

“Answer / Unit of Measurement” – Your Answers!

For Grantees Using the AFI 2 Program Management Tool:

“AFI2 Location for Pre-population” heading – The entry form or section of AFI 2 from which the system calculates answers.(The AFI 2 system calculates these answers using several different items in the AFI 2 data base.)

“Pre-population Note” – Guidance on whether the fields will be pre-populated by AFI 2 system or whether the granteeshould enter data themselves.

2007 Data Report Pre-population & Required Fields Guide October 17, 2007- Version 1

mailto:[email protected]

mailto:[email protected]



Table of Contents

Section Page

Section A. Grantee Contact Information 3Section B. AFI Project Structure 5Section C. AFI Project Features 12Section D. AFI IDA Account Holder Characteristics 26Section E. Project Reserve Accounts 46Section F. AFI IDA Account Holder Savings 48Section G. AFI IDA Account Holder Withdrawals 52Section H. Financial Data Summary Sheet 57Section I. 2007 AFI Grantee Information Update Form 58Section J. Characteristics of AFI IDA Account Holders Making a Matched 59

Withdrawal in the Past Year




Section A -- Grantee Contact InformationPlease enter contact name for questions about information submitted on this form. Use Section I to make corrections and changes to grantee agencycontact information listed below. Please answer question A.15 as well.

2007Form

Number Question/ Data Description

Answer/Unit of

MeasurementRequired?

AFI² Locationfor Pre-

populationPre-population

Note

A.1 Grantee Agency Name Thisautopopulates.Make changes inSection I if wrong.

Grantee FactsForm

Please make anychanges tocontactinformation inSection I.

A.2 Address 1 See above Grantee FactsForm

See above

A.3 Address 2 See above Grantee FactsForm

See above

A.4 City See above Grantee FactsForm

See above

A.5 State See above Grantee FactsForm

See above

A.6 Zip Code See above Grantee FactsForm

See above

A.7 Contact Name for questions aboutinformation submitted on this form.

Required. Pleaseedit if wrong.

n/a Please enter thisinformation.

A.8 Telephone Number Format Note : (___) ___-____

Required. Pleaseedit if wrong.


A.9 Fax Number Format Note : (___)___-____

Not required n/a Please enter thisinformation.

A.10 E-Mail Address Required. Pleaseedit if wrong.


A.11 Grant Number 90EI____ n/a Program MgtForm

Read only

A.12 Calendar Year Grant was Awarded n/a Program MgtForm

Read only

A.13 Reporting Period: Start Date:End Date:

n/a Program MgtForm

Read only




2007Form


Answer/Unit of



population

Pre-populationNote

A.14 Amount AFI Grant $ Thisautopopulates.Make changes inSection I if wrong.

n/a Read Only

A.15 Please describe the tools or methods(e.g., AFI 2 MIS IDA, other electronicsystem or manual review of files) used toobtain the information requested in thisreport.

Enter in text box. Required- Pleaseanswer.

n/a n/a




Section B -- AFI Project StructureThis section asks about the grantee organization and any sub-grantee or sub-contractor that offer IDAs funded with the AFI grant.

2007Form


Answer/Unit of



population

Pre-population

NoteAFI PROJECT TYPE

B.1 SINGLE AGENCY AFI PROJECT –Check here if the grantee manages aSingle Agency Project.

A Single Agency AFI Project is one runby a single organization. The oneagency opens AFI IDA Accounts either at one location or at several locations.A Single Agency Project does not have

sub-grantees or sub-contractors thatopen AFI IDAs

Check here if applies.

One of these threeis Required; mustchoose Single ORNetwork OR Other

n/a Please select.

B.2 NETWORK AFI PROJECT – Checkhere if the grantee manages a NetworkProject.

A Network AFI Project is one where thegrantee agency manages a number of sub-grantees or sub-contractors, eachof which open AFI IDAs as part of oneProject. AFI grant funds are receivedby one agency that distributes them to

multiple, independent agencies thatopen AFI IDA accounts.

Check here if applies.

One of these threeis Required; mustchoose Single ORNetwork OR Other.

n/a Please select.

B.3 OTHER – If the grantee administers adifferent type of AFI Project, pleasedescribe it in the text box.

Check here if applies. Givedescription in textbox.

If other is selected,a description isrequired to reachcompletion status.

n/a Please select.




2007Form


Answer/Unit of



population

Pre-populationNote

GRANTEE ORGANIZATIONB.4 AGENCY TYPE

Which of the following categories bestdescribes the grantee organization?Please choose only one. If your agencyfalls within multiple categories, pleasechoose the one that best describes your organization. We are interested in theprimary agency type for this question.

The data willhave a dropdown menu list.Choose one fromthe list.

Required n/a Please select.




2007Form


Answer/Unit of



population

Pre-populationNote

• Community Action Agency (non-profit)

• Community Action Agency(government agency)

• Community DevelopmentCorporation

• Credit Union• Economic Development Agency

(State/County/City governmentagency)

• Educational Institution• Faith-Based Organization• Housing Agency (State/County/City

government agency)• Housing Organization (non-profit)• Human Services Organization (non-

profit)• Human Services Agency


• Micro-Enterprise DevelopmentOrganization

• Refugee Resettlement Organization• United Way Organization• Workforce Development Agency


• Youth Development OrganizationB.5 Other

If the grantee organization type is not inthe list above, please choose “other” andprovide details.

The data form willhave a text boxwith room for acompletedescription.

If other ischosen, adescription isrequired.

n/a Please select.




2007Form


Answer/Unit of



population

Pre-populationNote

B.6 AGENCY BUDGETWhat is the grantee organization’s totalannual budget for the current year?

Note: This is your agency’s total annualbudget (as may be reported in an annualreport) and should include the budgetsfor all the programs and operations.

$ Required. 0 is anunacceptablevalue.

n/a Please enter.

PROJECT STAFFINGB.7 Estimate of the average number of hours

per week the grantee organization’semployees (including full-time and part-time employees) work on the AFI Project.

Hours per week Required. If answer is 0,mark 0. Do notleave blank.

n/a Please enter.

B.8 Estimate of the average number of hoursper week AmeriCorps personnel (VISTAor State or National AmericaCorppersonnel) work on the AFI Project.


n/a Please enter.

B.9 Estimate of the average number of hoursper week volunteers (other thanAmeriCorps personnel) contribute to theAFI Project.


n/a Please enter.

GRANTEE – SINGLE AGENCY AFIPROJECTIf the grantee organization administers aSingle Agency AFI Project, please

respond to the following statements.(Note : If the grantee organizationadministers a Network AFI Project,please skip this series of questions andgo to question B.18.)

B.10 The grantee organization recruits andenrolls participants.

Yes or No Required if Single waschosen

n/a Please select.

B.11 The grantee organization opens AFI IDAaccounts with participants.


n/a Please select.




2007Form


Answer/Unit of



population

Pre-populationNote

B.12 The grantee organization provides AFIIDA services from one location only.


n/a Please select.

B.13 The grantee organization tracksparticipant account activity.


n/a Please select.

B.14 The grantee organization providesparticipants with case management in-house.


n/a Please select.

B.15 The grantee organization hasarrangements whereby other organizations provide case managementto AFI participants.


n/a Please select.

B.16 The grantee organization reports to OCSabout the AFI Project. Yes or No Required if Single waschosen

n/a Please select.

B.17 The grantee organization is responsiblefor raising non-federal cash contributionfor the AFI grant.


n/a Please select.

GRANTEE – NETWORK AFI PROJECTIf the grantee organization administers aNetwork AFI Project, please respond tothe following statements. Thesestatements are about the granteeorganization only (they are not about any

sub-grantees or sub-contractors).

(Note : If the grantee organizationadministers a Single Agency AFI Project,skip this series and go to Section C.)

B.18 The grantee organization opens AFI IDAaccounts with participants.

Yes or No Required if Network OROther waschosen

n/a Please select.




2007Form


Answer/Unit of



population

Pre-populationNote

B.19 The grantee organization administers theNetwork AFI Project; it does not open AFIIDA accounts.


n/a Please select.

B.20 Partner agencies (sub-grantees or sub-contractors) open AFI IDA accounts.


n/a Please select.

B.21 The grantee organization provides AFIIDA services from multiple locations.


n/a Please select.

B.22 The grantee organization manages acentralized AFI Project Reserve Accountfor all its sub-grantees and sub-contractors (that open AFI accounts withparticipants).


n/a Please select.

B.23 The sub-grantees or sub-contractors thatopen AFI accounts each manageindividual AFI Project Reserve Accounts.


n/a Please select.

B.24 The grantee organization is responsiblefor raising the entire non-federal cashcontribution for the entire project.


n/a Please select.

B.25 The sub-grantees or sub-contractors areresponsible for raising a portion of thenon-federal cash contribution for the AFIProject.


n/a Please select.

B.26 The grantee organization uses acomputerized system to track accounttransactions for the entire AFI Project.


n/a Please select.




2007Form


Answer/Unit of



population

Pre-populationNote

B.27 The grantee organization is responsiblefor maintaining participants’documentation and records (e.g.,applications and bank statements) for reporting and evaluation purposes for theentire AFI Project.


n/a Please select.

SUB-GRANTEE AND SUB-CONTRACTOR ORGANIZATIONS –NETWORK AFI PROJECTS ONLYFor each sub-grantee or sub-contractor,please indicate the type of agency andthe average amount of staff andvolunteer hours worked on the AFIProject in a typical week.

(Note : If the grantee organizationadministers a Single Agency AFI Project,skip to Section C.)

B.28 How many sub-grantees or sub-contractors open AFI IDAs as part of thisAFI Project?

Required if Network OROther waschosen

B.29 Name of partner organization #1 Required if Network OROther waschosen

Check GranteeFacts for thisinformation.

Please enter.

B.30 Organization type The data form willhave a dropdown menu.Please selectfrom menu.

Required if Network OROther waschosen

n/a Please enter.

B.31 Average number of paid staff hours in atypical week.

Hours per week Required if Network OROther waschosen. If unknown, leaveblank.

n/a Please enter.




2007Form


Answer/Unit of



population

Pre-populationNote

B.32 Average number of volunteer staff hoursin a typical week.

Hours per week Required if Network OROther waschosen. If unknown, leaveblank.

n/a Please enter.

Only the firstpartner organization’squestions (B.30-32) is Required.

Grantee FactsForm

This is from thesubgrantee factsform.

The data form will have space for 15 sub-grantees or sub-contractors. More space will be available, if needed.




Section C -- AFI Project FeaturesPlease note that all questions are required for the assets that your organization offers.

2007

FormNumber

Question/ Data Description

Answer/

Unit of Measurement

Required?

AFI²Location for

Pre-population

Pre-

populationNote

SAVINGS PLAN AGREEMENTCHARACTERISTICSFREQUENCY AND SCHEDULE OFPARTICIPANT SAVINGS DEPOSITSPlease indicate whether the AFI Projectallows participants to make deposits aslisted below.

C.1 One-time deposits Yes or No Required n/a Please select.C.2 Weekly deposits Yes or No Required n/a Please select.C.3 Monthly deposits Yes or No Required n/a Please select.C.4 Quarterly deposits Yes or No Required n/a Please select.C.5 Other

(Note: If other, please provide details in thetext box.)


Not required n/a Please select.

C.6 WHAT IS THE MINIMUM AMOUNT APROJECT PARTICIPANT MAY DEPOSITTO OPEN AN AFI IDA ?

Note: If this varies, select the “varies”

response and provide details in the text box.

$ Required. If varies is selecteda description isrequired in text

box.

n/a Please enter.

C.7 WHAT IS THE MINIMUM REGULARDEPOSIT AMOUNT AND TIME PERIOD?

Indicate both the dollar amount and the timeunit. For example, $25 per month, or $10per week.

Note : If this varies, select the “varies”response and provide details in the text box.

$ per time period.


Required. If varies is selecteda description isrequired in textbox.

n/a Please enter.




2007Form


Answer/Unit of


AFI²Location for

Pre-population

Pre-population

Note

C.8 WHAT IS THE MAXIMUM AMOUNT OFAFI IDA SAVINGS THE AFI PROJECTWILL MATCH?

This is the maximum amount a participantcan save and receive match funds. It doesnot include the match money.

Note: If this varies, select the “varies”response and provide details in the text box.

$



n/a Please enter.

C.9 HOW MANY SCHEDULED DEPOSITSMAY AN AFI PROJECT PARTICIPANTMISS BEFORE THEY ARE TERMINATEDFROM THE PROJECT?If this varies, select the “varies” responseand provide details in the text box. If theymay not miss any deposits, enter 0.



n/a Please select.

WHAT TYPES OF ASSETS DOES THEAFI PROJECT ALLOW PARTICIPANTSTO SAVE FOR AND ACQUIRE?

n/a Please select.

C.10 Home purchase Yes or No Required n/a Please select.C.11 Education Yes or No Required n/a Please select.C.12 Business Yes or No Required n/a Please select.C.13 Transfer to Dependent Yes or No Required n/a Please select.

WHAT ARE THE MATCH RATE(S) FORTHE FOLLOWING USES?

If the match rate for a particular use haschanged over time, please provide details inthe text box. If the AFI Project does notoffer the allowable asset, please select“N/A” from the dropdown menu.

The form will havea drop down menuwith match ratesranging from 1:1 to8:1. It will alsohave a text boxwith room for acompletedescription of anyvariations.

Required if offered. If variesis selected, adescription isrequired for completion.

C.14 Home purchase Required n/a Please select.C.15 Education Required n/a Please select.




2007Form


Answer/Unit of


AFI²Location for

Pre-population

Pre-population

Note

C.16 Business Required n/a Please select.C.17 Transfer to Dependent Required

WHAT ARE THE MAXIMUM AMOUNT OFTIME PROJECT PARTICIPANTS MAYSAVE IN THEIR IDA?Please state the time in months.

Note: If this varies, select the “varies”response and provide details in the text box.If the AFI Project does not offer theallowable asset, please leave it blank.

Time is measuredin months.

Required if assetis offered. If varies isselected, then adescription isrequired.

C.18 Home Purchase Time in months Required n/a Please enter.

C.19 Education Time in months Required n/a Please enter.C.20 Business Time in months Required n/a Please enter.C.21 Transfer to Dependent Time in months Required n/a Please enter.

PARTICIPANT SERVICESTrainingPlease include information applicable for AFI Project participants.

Note : The number of participants who havecompleted any training type listed belowshould not be greater than the number reported for question D.4, “Total number of individuals who enrolled in the AFI IDAproject through September 2007.”

Please answer all questions for each type of asset goal offered by the grantee. If thegrantee offers the goal, but the answer iszero, please enter 0 (do not leave it blank).Leave blank if not offered.

Trainingquestions arerequired if assetis offered.

Financial Literacy Training C22-25 requiredif financial literacytraining isoffered.




2007Form


Answer/Unit of


AFI²Location for

Pre-population

Pre-population

Note

C.22 Total number of hours each participant isrequired to complete.

Hours Required n/a Please enter.

C.23 Number of times a year that the financialliteracy training, in its entirety, is offered

Note: If this varies, select the “varies”response and provide details in the text box.If the AFI Project does not offer theallowable asset, please select n/a.

Required if offered. If variesis selected, thendescription isrequired.

n/a Please enter.

C.24 Number of participants who have completedthe training through September 30, 2007.

Participants Required n/a Please enter.

C.25 What curriculum is used for financial literacytraining? Please choose from the dropdownmenu. If other is chosen please indicate thecurriculum used.

Required

Asset Specific Training – HomePurchase and Ownership

C26-28 arerequired if homeownership isoffered.



C.27 Number of times per year that the homeownership, in its entirety, is offered


Required if offered. If variesis selected, then

description isrequired.

n/a Please enter.



Asset Specific Training – Education C29-31 arerequired if education trainingis offered.






2007Form


Answer/Unit of


AFI²Location for

Pre-population

Pre-population

Note

C.30 Number of times per year that the educationtraining, in its entirety, is offered



n/a Please enter.



Asset Specific Training – Business C 32-34 arerequired if education trainingis offered.



C.33 Number of times per year that the businesstraining, in its entirety, is offered.



n/a Please enter.






C. OTHER SERVICES AND ASSISTANCEThis section asks for grantees to indicate any types of services and assistance offered to AFI IDA Account Holders. For each type of service or assistance listed, please indicate whether it was offered to participants, how it was provided, and the number or participants who received the service or assistance.

(Note : The on-line response form will feature drop down choices for each type of service of assistance provided.)

2007Form

Number

Type of Service or Assistance

Offered to AFIParticipants?

- Yes, to ALL- Yes, to SOME

- Not offered- Don’t Know

How Provided?

-By Grantee-Outsourced

-Both

Number of AFIParticipants who

have Received thisServices or Assistance

Required?

AFI²Location

for Pre-

population

Pre-population

Note

Personal and

EmploymentInterventions

Required Req’d IF Yes to ALL

or Yes to SOMEselected; not req’d if Not offered or Don’tKnow selected

Req’d IF Yes to ALL

or Yes to SOMEselected; not req’d if Not Offered or Don’tKnow selected

See each

column tothe left.

n/a Please

select.

C.35 EmploymentSupport

Required Req’d IF Yes to ALLor Yes to SOMEselected; not req’d if Not offered or Don’tKnow selected

Req’d IF Yes to ALLor Yes to SOMEselected; not req’d if Not offered or Don’tKnow selected

See eachcolumn tothe left.

n/a Pleaseselect.

C.36 Child Care Required Req’d IF Yes to ALLor Yes to SOMEselected; not req’d if

Not offered or Don’tKnow selected

Req’d IF Yes to ALLor Yes to SOMEselected; not req’d if

Not offered or Don’tKnow selected


n/a Pleaseselect.

C.37 Transportation Required Req’d IF Yes to ALLor Yes to SOMEselected; not req’d if Not offered or Don’tKnow selected



n/a Pleaseselect.

C.38 Medical(treatment)




n/a Pleaseselect.




2007Form

Number





How Provided?


-Both



Required?

AFI²Location

for Pre-

population

Pre-population

Note

C.39 Crisismanagement




n/a Pleaseselect.

C.40 Structuredplanningexercises




n/a Pleaseselect.

C.41 Mentoring Required Req’d IF Yes to ALLor Yes to SOMEselected; not req’d if Not offered or Don’tKnow selected


See eachcolumn tothe left..

n/a Pleaseselect.

C.42 Peer Support Required Req’d IF Yes to ALLor Yes to SOMEselected; not req’d if Not offered or Don’tKnow selected



n/a Pleaseselect.

C.43 Other (pleasedescribe)




n/a Pleaseselect.

C.43.(a) Other (pleasedescribe)




n/a Pleaseenter.

FinancialInterventions




2007Form

Number





How Provided?


-Both



Required?

AFI²Location

for Pre-

population

Pre-population

Note

C.44 Cash grant Required Req’d IF Yes to ALLor Yes to SOMEselected; not req’d if Not offered or Don’tKnow selected



n/a Pleaseselect.

C.45 Counseling Required Req’d IF Yes to ALLor Yes to SOMEselected; not req’d if Not offered or Don’tKnow selected



n/a Pleaseselect.

C.46 Loans Required Req’d IF Yes to ALLor Yes to SOMEselected; not req’d if Not offered or Don’tKnow selected



n/a Pleaseselect.

C.47 Credit Repair Required Req’d IF Yes to ALLor Yes to SOMEselected; not req’d if Not offered or Don’tKnow selected



n/a Pleaseselect.

C.48 Other (pleasedescribe)




n/a Pleaseselect.

C.48.(a) Other (pleasedescribe)




n/a Pleaseenter.




2007Form

Number





How Provided?


-Both



Required?

AFI²Location

for Pre-

population

Pre-population

Note

C.49 Specialized or AdvancedFinancialEducation




n/a Pleaseselect




SOURCES OF FUNDINGPlease indicate all sources of funding the grantee organization uses or used to support the AFI Project. Please indicate whether the funding was for operating expenses, participant match dollars, both. If the grantee did not receive any funding from the sources, please indicate that, too. Pleaseprovide any details in the text box.

2007Form

Number Government Funding

OperatingExpenses

Check if Yes

ParticipantMatch

Dollars

Check if Yes

BothUses

Checkif Yes

Checkthis box if no

fundingreceivedfrom thissource.

RequiredAFI² Location

for Pre-population

Pre-population

Note

C.50 Assets for IndependenceProgram grant

Required—one radiobuttonMUST be

selected

n/a Please select

C.51 Federal Home LoanBank

Required—one radiobuttonMUST beselected

n/a Please select

C.52 U.S. Department of Health and HumanServices / Office of Refugee Resettlement


n/a Please select

C.53 U.S. Department of Health and HumanServices / CommunityServices Block Grants(CSBG)


n/a Please select

C.54 U.S. Department of Health and HumanServices / Other (Pleasename the program in thetext box.)


n/a Please select




2007Form


OperatingExpenses

Check if Yes

ParticipantMatch

Dollars

Check if Yes

BothUses

Checkif Yes

Checkthis box if

nofundingreceivedfrom thissource.


for Pre-population

Pre-population

Note

C.55 U.S. Department of Housing and UrbanDevelopment /CommunityDevelopment BlockGrant (CDBG)


n/a Please select

C.56 U.S. Department of Housing and UrbanDevelopment / Hope VI

Required—one radiobutton

MUST beselected

n/a Please select

C.57 U.S. Department of Housing and UrbanDevelopment / Other (Please list the programand specify details in thetext box.)


n/a Please select

C.58 U.S. Department of Labor (Please list the programand specify details in the

text box.)


selected

n/a Please select

C.59 Local governmentfunding.(Please list the programand specify details in thetext box.)


n/a Please select

C.60 Local Housing Authority(Please list the programand specify details in thetext box.)


n/a Please select




2007Form


OperatingExpenses

Check if Yes

ParticipantMatch

Dollars

Check if Yes

BothUses

Checkif Yes

Checkthis box if



for Pre-population

Pre-population

Note

C.61 Local Housing Authority /Family Self SufficiencyProgram


n/a Please select

C.62 Local government taxcredits(Please list the programand specify details in the

text box.)


selected

n/a Please select

C.63 State governmentfunding(Please list the programand specify details in thetext box.)


n/a Please select

C.64 State tax credits(Please list the programand specify details in thetext box.)


n/a Please select

C.65 State welfare programfunds(Please list the programand specify details in thetext box.)


n/a Please select

C.66 Public EducationInstitutions(Please list the programand specify details in thetext box.)


n/a Please select




2007Form


OperatingExpenses

Check if Yes

ParticipantMatch

Dollars

Check if Yes

BothUses

Checkif Yes

Checkthis box if



for Pre-population

Pre-population

Note

C.67 Businesses (Please listdonors in the text box.)


n/a Please select

C.68 Civic or Fraternalorganizations (Please listdonors in the text box.)


selected

n/a Please select

C.69 Faith-BasedOrganizations (Pleaselist donors in the textbox.


n/a Please select

C.70 Financial Institutions(Please list donors in thetext box.)


n/a Please select

C.71 Individuals(Please list donors in thetext box.)


n/a Please select

C.72 Local United Way Required—one radiobuttonMUST beselected

n/a Please select




2007Form


OperatingExpenses

Check if Yes

ParticipantMatch

Dollars

Check if Yes

BothUses

Checkif Yes

Checkthis box if



for Pre-population

Pre-population

Note

C.73 Foundations Required—one radiobuttonMUST beselected

n/a Please select

C.74 Other (Please describein the text box.)

Notrequired

n/a Please select

C.75 What is your AFI IDAproject's target

population?

Note : Please choose allcategories that apply byholding down the controlkey and makingselection(s).

Required n/a Please select




Section D – AFI IDA Account Holder Characteristics

This section asks about the AFI IDA Account Holders as of the day they enrolled in the AFI Project. An AFI IDA Account Holder is a participant who hasopened an AFI IDA account through the program on which you are reporting. An AFI Project Enrollee is a participant who is receiving services under theAFI Project (such as financial literacy training), but has not opened an AFI IDA account. The questions request cumulative data from the date the

AFI Project began through September 30, 2007. • If data is known for some, but not all AFI IDA Account Holders, please provide the number for which is it unknown in the “unknown” field.

• Please provide total numbers of AFI IDA Account Holders, including those who have already closed their account for any reason.

If the Project did not collect a particular data element from the AFI Account Holders, please check the “did not collect” response.

2007Form


Answers/Units of


AFI²

Location for Pre-population

Pre-population

Note

D.1 NUMBER OF AFI PROJECT ENROLLEESAND AFI IDA ACCOUNT HOLDERSDid the grantee collect data on thistopic?

Yes or No Required n/a Please enter yes or no.

D.2 As of September 30, 2007, total number of individuals who attended an AFI Projectorientation or informational meeting.

Required if yes isselected

n/a Please enter.

D.3 As of September 30, 2007, total number of individuals who submitted an applied for enrollment in the AFI Project.


n/a Please enter.

D.4 As of September 30, 2007, total number of individuals who were enrolled in the AFIProject.


ParticipantInformationForm

This is a count of all participantsper this grant #,who are in thisform.




2007Form


Answers/Units of


AFI²Location for

Pre-population

Pre-population

Note

D.5 As of September 30, 2007, total number of

individuals who opened an AFI IDA account.

(Note : If the Project allows participants toopen IDA accounts when they enroll in theprogram, the answers for D4 and D5 will bethe same.)

Required if yes is

selected

Participant

Accts Form

This is a count of

all participants,per this grant #for whom thereis a record in thisform.

D.6 GENDER OF AFI IDA ACCOUNTHOLDERS

Please indicate the number of AFI IDAAccount holders in each of the followingdemographic categories.

Did the grantee collect data on this topic? Yes or No Required n/a Please selectD.7 Male If D6 is yes, then

D7-9 are required.If the amount is 0,mark 0.

ParticipantInformationForm, Intake 1Tab

This is a count of all records in thisform and thistab, who alsohave a record inPartic Acctsform.

D.8 Female If D6 is yes, thenD7-9 are required.If the amount is 0,mark 0.



D.9 Unknown If D6 is yes, thenD7-9 are required.If the amount is 0,mark 0.

n/a Please enter.




2007Form


Answers/Units of


AFI²Location for

Pre-population

Pre-population

Note

D.10 RACE/ETHNICITY OF AFI IDA ACCOUNT

HOLDERS

Please indicate the number of AFI IDAAccount Holders in each of the followingdemographic categories.

For any “Other” response, please providedetails about these individuals in the textbox.

Note for Hispanic Category: In cases wherea participant, for example, may be both

Hispanic and another category, pleasereport them as Hispanic for purposes of thissurvey.Did the grantee collect data on this topic? Yes or No Required n/a Please select.

D.11 African American If D10 is yes, thenD11-17 are required.If the amount is 0,mark 0.



D.12 Asian American / Pacific Islander If D10 is yes, then


Participant

InformationForm, Intake 1Tab

This is a count of

all records in thisform and thistab, who alsohave a record inPartic Acctsform.




2007Form


Answers/Units of


AFI²Location for

Pre-population

Pre-population

Note

D.13 Caucasian If D10 is yes, then


Participant


This is a count of


D.14 Hispanic If D10 is yes, thenD11-17 are required.If the amount is 0,mark 0.


This is a count of all records in thisform and thistab, who alsohave a record inPartic Accts

form.D.15 Native American If D10 is yes, then




D.16 Other (please specify number and providedetails in text box)


If D10 is yes, thenD11-17 are required.If the amount is 0,mark 0.



D.17 Number of Unknown If D10 is yes, thenD11-17 are required.If the amount is 0,mark 0.

n/a Please enter.




2007Form


Answers/Units of


AFI²Location for

Pre-population

Pre-population

Note

D.18 AGE GROUP OF AFI ACCOUNT

HOLDERS AT TIME OF ENROLLMENT


(The sum of these should be the number reported in question D.5.)Did the grantee collect data on this topic? Yes or No Required n/a Please select.

D.19 19 years and under If D18 is yes, thenD19-24are required.If the amount is 0,

mark 0.

n/a Please enter;AFI² needs a fixfor this question.

D.20 20-29 years If D18 is yes, thenD19-24are required.If the amount is 0,mark 0.






D.23 50 years and older If D18 is yes, thenD19-24are required.If the amount is 0,mark 0.


D.24 Unknown If D18 is yes, thenD19-24are required.If the amount is 0,mark 0.

n/a Please enter;AFI² needs a fixfor this question




2007Form


Answers/Units of


AFI²Location for

Pre-population

Pre-population

Note

D.25 MARITAL STATUS OF AFI IDA ACCOUNT

HOLDERS AT TIME OF ENROLLMENT


For any “Other” response, please providedetails about these individuals in text box.


D.26 Single, never married If D25 is yes, thenD25-32are required.If the amount is 0,mark 0.



D.27 Married If D25 is yes, thenD25-32are required.If the amount is 0,mark 0.


This is a count of all records in thisform and thistab, who alsohave a record in

Partic Acctsform.D.28 Separated If D25 is yes, then

D25-32are required.If the amount is 0,mark 0.






2007Form


Answers/Units of


AFI²Location for

Pre-population

Pre-population

Note

D.29 Divorced If D25 is yes, then

D25-32are required.If the amount is 0,mark 0.

Participant


This is a count of


D.30 Widowed If D25 is yes, thenD25-32are required.If the amount is 0,mark 0.



form.D.31 Other (please specify number and provide

details in the text box)The data form willhave a text boxwith room for acompletedescription.

If D25 is yes, thenD25-32are required.If the amount is 0,mark 0.



D.32 Number of Unknown If D25 is yes, thenD25-32are required.If the amount is 0,mark 0.

n/a Please enter.

D.33 EMPLOYMENT STATUS OF AFI IDAACCOUNT HOLDER AT TIME OFENROLLMENT

Please indicate the number of AFI IDAAccount Holders who reported the followingemployment status categories.





2007Form


Answers/Units of


AFI²Location for

Pre-population

Pre-population

Note

D.34 Full Time Employed If D33 is yes, then

D34-40 arerequired. If theamount is 0, mark 0.

Participant


This is a count of


D.35 Part Time Employed If D33 is yes, thenD34-40 arerequired. If theamount is 0, mark 0.



form.D.36 Unemployed If D33 is yes, then




D.37 Student

(Note : If a participant was a student andalso working, please include them in the“Full Time Employed” or “Part TimeEmployed” data field, as appropriate. Donot count them as a “student”.)

If D33 is yes, thenD34-40 arerequired. If theamount is 0, mark 0.



D.38 Retired If D33 is yes, thenD34-40 arerequired. If theamount is 0, mark 0.






2007Form


Answers/Units of


AFI²Location for

Pre-population

Pre-population

Note

D.44 Completed grades 9-11 If D41 is yes, then


Participant


This is a count of


D.45 High School Diploma If D41 is yes, thenD42-52 arerequired. If theamount is 0, mark 0.



form.D.46 Vocational School Diploma / Degree If D41 is yes, then




D.47 Some College If D41 is yes, thenD42-52 arerequired. If theamount is 0, mark 0.



D.48 AA Degree / Graduated two-year college If D41 is yes, thenD42-52 arerequired. If theamount is 0, mark 0.






2007Form


Answers/Units of


AFI²Location for

Pre-population

Pre-population

Note

D.49 BA/BS Degree / Graduated four-year

college

If D41 is yes, then


Participant


This is a count of


D.50 Some Graduate School / Attended GraduateSchool




form.D.51 MA/MS, etc. Graduate Degree(s) If D41 is yes, then




D.52 Unknown If D41 is yes, thenD42-52 arerequired. If theamount is 0, mark 0.

n/a Please enter.

D.53 LOCATION TYPE AT TIME OFENROLLMENT

Please indicate the number of AFI IDAAccount Holders who reported their primaryaddress as one of the following geographiccategories.

(Note: The sum of these should be thenumber reported in question D.5.)Did the grantee collect data on this topic? Yes or No Required n/a Please select.




2007Form


Answers/Units of


AFI²Location for

Pre-population

Pre-population

Note

D.54 Major urban area (metropolitan statistical

area with population greater than1,000,000)

If D53 is yes, then


Participant


This is a count of

all records in thisform and thistab, who alsohave a record inParticipant Acctsform.

D.55 Minor urban area (metropolitan statisticalarea with population less than 1,000,000)



This is a count of all records in thisform and thistab, who alsohave a record inParticipant Accts

form.D.56 Rural/Remote Area If D53 is yes, then



This is a count of all records in thisform and thistab, who alsohave a record inParticipant Acctsform.


n/a See above




2007Form


Answers/Units of


AFI²Location for

Pre-population

Pre-population

Note

D.58 HOUSEHOLD COMPOSITION (ADULT) AT

TIME OF ENROLLMENT

Please indicate the number of AFI IDAAccount Holders who reported the followingcategories of adults (age 18 and older) livedin their household at time of enrollment.Please include the account holder in thecount.


D.59 One adult If D58 is yes, thenD59-65 arerequired. If theamount is 0, mark 0.

n/a Please enter.

D.60 Two adults If D58 is yes, thenD59-65 arerequired. If theamount is 0, mark 0.

n/a Please enter.

D.61 Three adults If D58 is yes, thenD59-65 arerequired. If theamount is 0, mark 0.

n/a Please enter.

D.62 Four adults If D58 is yes, thenD59-65 arerequired. If theamount is 0, mark 0.

n/a Please enter.

D.63 Five adults If D58 is yes, thenD59-65 arerequired. If theamount is 0, mark 0.

n/a Please enter.




2007Form


Answers/Units of


AFI²Location for

Pre-population

Pre-population

Note

D.64 Six or more adults If D58 is yes, then


n/a Please enter.

D.65 Number of Unknown If D58 is yes, thenD59-65 arerequired. If theamount is 0, mark 0.

n/a Please enter.

D.66 HOUSEHOLD COMPOSITION (CHILD) ATTIME OF ENROLLMENT

Please indicate the number of AFI IDAAccount Holders who reported that the

following categories of children (age 17 andyounger) lived in their household at time of enrollment.

(Note : The sum of these should be thenumber reported in question D.5.)Did the grantee collect data on this topic? Yes or No Required n/a Please select.

D.67 No children If D66 is yes, thenD67-74 arerequired. If theamount is 0, mark 0.

n/a Please enter.

D.68 One child If D66 is yes, thenD67-74 arerequired. If theamount is 0, mark 0.

n/a Please enter.

D.69 Two children If D66 is yes, thenD67-74 arerequired. If theamount is 0, mark 0.

n/a Please enter.

D.70 Three children If D66 is yes, thenD67-74 arerequired. If theamount is 0, mark 0.

n/a Please enter.




2007Form


Answers/Units of


AFI²Location for

Pre-population

Pre-population

Note

D.71 Four children If D66 is yes, then


n/a Please enter.

D.72 Five children If D66 is yes, thenD67-74 arerequired. If theamount is 0, mark 0.

n/a Please enter.

D.73 Six or more children If D66 is yes, thenD67-74 arerequired. If theamount is 0, mark 0.

n/a Please enter.

D.74 Number of Unknown If D66 is yes, thenD67-74 arerequired. If theamount is 0, mark 0.

n/a Please enter.

D.75 REPORTED EARNED INCOME AT TIMEOF ENROLLMENT

Please indicate the number of AFI IDAAccount Holders who reported earnedincome at the following levels at the time or enrollment.

(Note : The sum of these should be thenumber reported in question D.5.)Did the grantee collect data on this topic? Yes or No Required n/a Please select.

D.76 Below the federal poverty line. If D75 is yes, thenD76-80 arerequired. If theamount is 0, mark 0.


D.77 100 – 150 percent of the federal poverty line If D75 is yes, thenD76-80 arerequired. If theamount is 0, mark 0.





2007Form


Answers/Units of


AFI²Location for

Pre-population

Pre-population

Note

D.78 150 – 200 percent of the federal poverty line If D75 is yes, then


n/a Please enter;

AFI² needs a fixfor this question.

D.79 More than 200 percent of the federalpoverty line




n/a Please enter;AFI2 needs a fixfor this question.

D.81 AUTOMOBILE OWNERSHIP ATENROLLMENTDid the grantee collect data on this topic? Yes or No Required n/a Please select.

D.82 Number of AFI IDA Account Holders whoowned an automobile at the time of enrollment.


EligDeterminationForm, Assets &LiabilitiesSection, alsostored andviewable inPartic Infoform, Assets/Liabilitiessection



n/a Please enter;AFI2 needs a fixfor this question.

D.84 HOME OWNERSHIP AT ENROLLMENTDid the grantee collect data on this topic? Yes or No Required n/a Please select.




2007Form


Answers/Units of


AFI²Location for

Pre-population

Pre-population

Note

D.85 Number of AFI IDA Account Holders who

owned a home at the time of enrollment.

If D84 is yes, then


Elig

DeterminationForm, Assets &LiabilitiesSection alsostored andviewable inPartic Infoform, Assets/Liabilitiessection

This is a count of


D.86 Unknown If D84 is yes, thenD85-86 are

required. If theamount is 0, mark 0.

n/a This should bezero.

D.87 BUSINESS OWNERSHIP AT TIME OFENROLLMENTDid the grantee collect data on this topic? Yes or No Required n/a Please select.

D.88 Number of AFI IDA Account Holders whoowned a business at the time of enrollment.


EligDeterminationForm, Assets &LiabilitiesSection alsostored andviewable in

Partic Infoform, Assets/Liabilitiessection




D.90 RECIPIENTS OF TANF BENEFITSDid the grantee collect data on this topic? Yes or No Required n/a Please select.




2007Form


Answers/Units of


AFI²Location for

Pre-population

Pre-population

Note

D.91 Number of AFI IDA Account Holder who

were TANF recipients at the time or enrollment.

If D90 is yes, then


Participant

Information,Intake 2

This is a count of




D.93 RECIPIENTS OF EITC PAYMENTSDid the grantee collect data on this topic? Yes or No Required n/a Please select.

D.94 Number of AFI IDA account holders whohad ever received EITC refunds at time of enrollment.

Note : It is important to make a distinctionbetween those who are EITC eligible andthose who applied for and received EITC“payments.” Include ONLY thoseindividuals who received EITC payments.




n/a Please enter.

D.96 SAVINGS ACCOUNT ACTIVITY ANDACCOUNT STRUCTUREDid the grantee collect data on this topic? Yes or No Required n/a Please select.

D.97 Number of AFI IDA account holders whohad ever owned a Checking Account prior toopening an AFI IDA account.

Required if known. n/a Please Enter;AFI² asks if participant had achecking acct atthe time of enrollment.




2007Form


Answers/Units of


AFI²Location for

Pre-population

Pre-population

Note

D.106 Business If D103 is yes, then

D104-108 arerequired. If answer is 0, mark 0.

Participant Acct

Form, IntendedUse field

This is a count of


D.107 Transfer to a dependent’s IDA If D103 is yes, thenD104-108 arerequired. If answer is 0, mark 0.

Participant AcctForm, IntendedUse field


form.D.108 Unknown If D103 is yes, thenD104-108 arerequired. If answer is 0, mark 0.

n/a Please enter.




Section E – Project Reserve Accounts

2007Form


Answers/Units of

MeasurementRequired? AFI² Location for

Pre-populationPre-population

Note

E.A. AFI GRANTS, NON-FEDERALFUNDS, and the PROJECT RESERVEACCOUNT

E.1 Amount of AFI Grant award $ Required n/a Please enter.E.2 Amount of non-Federal cash

contribution pledged in the AFI grantapplication.

$ Required n/a Please enter.

E.3 As of September 30, 2007, total amountof AFI Grant award ever drawn downand deposited into the Project ReserveAccount.

(Please do not adjust for any grantfunds used for any reason or disbursedto participants.)


E.4 As of September 30, 2007, total amountof non-Federal cash contribution ever deposited into the Project ReserveAccount.(Please do not adjust for any amount of funds used for any reason or disbursedto participants.)


E.5 PROJECT RESERVE ACCOUNTFINANCIAL INSTITUTIONS

Name(s) of Financial Institution(s)where any portion of the ProjectReserve Account was on deposit onSeptember 30, 2007. Provide the totalaccount balance at each institution onSeptember 30, 2007.

(Note : Unlike items E.2 and E.4, herewe are looking for the balance,accounting for both deposits andwithdrawals.)




2007Form


Answers/Units of

MeasurementRequired? AFI² Location for

Pre-populationPre-population

Note

HOW MANY FINANCIALINSTITUTIONS HOLD A PORTION OF

THE PROJECT RESERVEACCOUNT? (TOTAL NUMBER OFINSTITUTIONS)

Required n/a Please enter number.

E.6 Name(s) of Financial Institution #1 thatheld any part of the Project ReserveAccount on September 30, 2007.

Required Bank Statements,Reserve FundAccts Form,Institution Namefield

E.7 Total amount of Project ReserveAccount on deposit at this institution onSeptember 30, 2007.

$ Required Bank Statements,Reserve FundAccts Form,September 30,

2007 EndingBalanceE.25 Total amount of Project Reserve

Account on deposit at all financialinstitutions as of September 30, 2007.

Please provide the total amount in theProject Reserve Account. If the ProjectReserve Account is held in multiplefinancial institutions, this is the sum of the balances in all institutions.

$ Required n/a Thisautocalculates onthe web form,based onamounts pre-populated or entered.

More space will be made available for all financial institutions, if necessary.




Section F -- AFI IDA Account Holder Savings

2007Form

Number Question/ Data Description Answers/

Unit of Measurement Required?AFI² Location

for Pre-population

Pre-population

NoteF.1 TOTAL NUMBER OF AFI IDA

ACCOUNT HOLDERS ORIGINALLYANTICIPATED, AS INDICATED IN THEGRANT PROPOSAL.

Required n/a Please enter.

F.2 CURRENT EXPECTATION OF THENUMBER OF AFI IDA ACCOUNTHOLDERS.

If the total number of planned AFI IDAaccount holders (under this AFI grant)has changed since the grant award,please enter the current expectationhere. If it has not changed, pleaseenter the originally anticipated number.

Required n/a Please enter.

F.3 DIFFERENCE BETWEEN NUMBEROF AFI IDA ACCOUNT HOLDERSORIGINALLY PLANNED ANDCURRENTLY PLANNED. IF NODIFFERENCE, SKIP TO F9.

Not required n/a The web formautocalculatesthis, based onentries into F1& F2.

WHAT WERE THE REASONS FORANY CHANGE?

Required if there is adifferencebetween F1and F2

n/a Please select.

F.4 Incomplete use of match funds by AFIIDA Account Holders

Yes or No See above n/a Please select.

F.5 Change in program features (match rateor maximum savings matched)

Yes or No See above n/a Please select.

F.6 Terminations Yes or No See above n/a Please select.F.7 Recruitment difficulties Yes or No See above n/a Please select.F.8 Other (Please provide details in the text

box.)Provide details if there isa difference other thanthose listed.

See above n/a Please select.




2007Form



for Pre-population

Pre-population

NoteF.9 AS OF SEPTEMBER 30, 2007,

NUMBER OF AFI IDA ACCOUNTSEVER OPENED.This number should reflect all AFIaccounts ever opened between thegrant start date and September 30,2007, regardless of their current status.Therefore, please include in this countall accounts that are currently open,those closed due to matchedwithdrawals, and those closed due toterminations or voluntary withdrawals.

This number should equal the number reported in D.5 above.

Required Participant AcctsForm

This is a countof all records inthis form.

NUMBER OF AFI IDA ACCOUNTSEVER CLOSED.This number should reflect all AFI IDAaccounts that have been closed for anyreason – that is, after a successfulasset purchase or termination for anyreason.

F.10 Number of closed AFI IDA accounts for which the participant received matchingfunds (a matched withdrawal)

Required Participant AcctsForm, AcctsClosed Field

This is a countof all closedaccts for reason of

reached IDAgoal.F.11 Number of closed AFI IDA accounts for

which the participant was terminated or made an voluntary withdrawal (anunmatched withdrawal).

Required Participant AcctsForm, AcctsClosed Field

This is a countof all closedaccts for reasons other than reachedIDA goal.




2007Form



for Pre-population

Pre-population

NoteF.12 TOTAL AMOUNT OF FUNDS THAT

AFI IDA PARTICIPANTS EVERDEPOSITED INTO THEIR AFI IDAACCOUNTS.Hint: This amount is roughly equal tothe sum of the total amount of currentaccount balances (reported in F.61) plusthe total amount of participantwithdrawals (reported in G.4,G.10,G.16, G.22, G.28, and G.32.)

$ Required Bank StatementsForm, DepositsSubForm

This is a sum of all deposits byall participants.

NUMBER OF AFI IDA ACCOUNTHOLDERS WHO USE AUTOMATICALLOTMENT / DEPOSITPROCEDURES.

n/a

F.13 DID THE GRANTEE COLLECT THISDATA? Yes or No Required Enter yes or no.

F.14 Number of AFI IDA account holders whohave money transferred into their AFIIDA accounts, whether from another bank account or through direct deposit.

Not required Please enter.

NAMES OF PARTNER FINANCIALINSTITUTIONS AND TOTAL AFI IDAACCOUNT BALANCES ON DEPOSITIN THOSE INSTITUTIONS AS OFSEPTEMBER 30, 2005.(Note : Unlike Items F.12 above where

we asked for the total amount ever deposited into the AFI IDAs, here weare looking for the current balances onSeptember 30, 2007, accounting for alldeposits and minus all withdrawals.)

Number of total financial institutions.

Required.Please enter number.

n/a Please enter.

F.15 Name of Participant Account FinancialInstitution #1

Required for allpartner financialinstitutions

n/a Please enter.




2007Form



for Pre-population

Pre-population

NoteF.16 Number of AFI IDA accounts open at

that institution on September 30, 2007Required for allpartner financialinstitutions

n/a Please enter.

F.17 Amount of funds in AFI IDA accounts atthat institution on September 30, 2007

$ Required for allpartner financialinstitutions

n/a Please enter.

F.60 Total Number of AFI IDA Accounts openat all financial institutions

Required Please enter.Hint: This is thesum of F16,19,22,25,28,31,34,37,40,43,46,

49,52,53,56,59.F.61 Total Amount of Funds in AFI IDAAccounts at all instituations

$ Required Please enter.Hint: This is thesum of F17,20,23,26,29,32,35,38,41,44,47,50,53, 56, 59.

The data form will have space for 15 Partner Financial Institutions (F.18- F.59). More space will be made available, if needed.




SECTION G -- AFI IDA Account Holder WithdrawalsThis section asks for information about the number, amount and asset goal of participant AFI IDA withdrawals. We are interested in information about thefunds disbursed from the AFI grant and non-federal cash contribution. All amounts should be cumulative – reflecting withdrawal activity from thebeginning of the grant period through September 30, 2007.

2007FormNumber

Question/ Data Description Answer/Unit of Measurement

Required? AFI² Locationfor Pre-population

Pre-populationNote

CATEGORIES OF WITHDRAWALS

Please answer all questions for eachtype of asset goal offered by thegrantee. If the grantee offers thegoal, but the answer is zero, pleaseenter 0 (do not leave it blank). If thegrantee does not offer a particular type of asset goal, please leave theanswers for that asset goal blank.

G.1 Home Purchase-Please check if offered.

Yes or No Required.

G.2 Total number of withdrawals made for this purpose.

Required if answer to G1 isyes.

IDA BankStatements Form,WithdrawalsSubForm

This is a count of allwithdrawals made byall participants for this purpose.

G.3 Total number of participants who madewithdrawals for this purpose.



This is a count of allparticipants whomade anywithdrawals for thispurpose.

G.4 Total amount of funds withdrawn fromparticipant IDAs for this purpose (do notinclude match funds).



This is a sum of allwithdrawals by allparticipants for thispurpose.




2007Form


Answer/Unit of



population

Pre-populationNote

G.5 Total amount of AFI Grant fundsdisbursed as matching funds for thispurpose.



This is a sum of allamounts matchedfor all withdrawalswhere OCS was thematching fundingpartner.

G.6 Total amount of non-federal cashcontribution disbursed as matchingfunds for this purpose.


n/a Please enter

G.7 Education- Please check if offered. Yes or No Required.


Required if answer to G7 is

yes

IDA BankStatements Form,

WithdrawalsSubForm

This is a count of allwithdrawals made by

all participants for this purpose.


Required if answer to G7 isyes



G.10 Total amount of funds withdrawn fromparticipant IDAs for this purpose (notincluding match funds).










n/a Please enter.

G.13 Business- Please check if offered. Yes or No Required




2007Form


Answer/Unit of



population

Pre-populationNote


Required if answer to G13is yes







G.16 Total amount of funds withdrawn fromparticipant IDAs for this purpose (notincluding match funds).










n/a Please enter.

G.19 Transfer to Dependent’s IDA-Please

check if offered.

Yes or No Required












2007Form


Answer/Unit of



population

Pre-populationNote

G.22 Total amount of funds withdrawn fromparticipant IDAs for this purpose (not

including match funds).

Required if answer to G19

is yes

IDA BankStatements Form,

WithdrawalsSubForm

This is a sum of allwithdrawals by all

participants for thispurpose.







n/a Please enter.

G.25 Emergency-Please check if offered.

Emergency withdrawals are those thatare made by participants withpermission from the AFI Projectmanagers to meet such emergenciesas medical expenses, etc.

Yes or No Required.









G.28 Total amount of funds withdrawn fromparticipant IDAs (not including matchingfunds)







2007Form


Answer/Unit of



population

Pre-populationNote

G.29 Voluntary or “Non-Approved”Withdrawals and Withdrawals due to

Terminations - Please check if offered.

Voluntary withdrawals are those thatare made by the participant for apurpose other than for an approvedasset purchase or in the event of anemergency. Participants who makesuch withdrawals either quit the Projector are terminated from it.

Yes or No Required n/a Please enter.

G.30 Total number of non-approvedwithdrawals




G.31 Total number of participants who madenon-approved withdrawals.




G.32 Total amount of funds withdrawn fromparticipant IDAs (not including matchingfunds)




G.33 Comment Section: Please use thissection to further explain any responsesgiven in this form.

Not Required

COMMENT SECTION:

Please use this section to explain any responses given in the form.




Section H: Financial Data Summary Sheet

Calculation Item Description Reporting Form ItemNumber Amount Reported

A) Checks to ensure current reserve balance reasonableness:Total Reserve Deposits Sum of Items:

E3 + E4A1

Minus Total Match Funds Disbursed toParticipants

Sum of Items: G5 + G6 +G11 + G12 + G17 + G18+ G23 + G24 =

- A2

Equals Calculated Reserve Balance = A3

Compare To Reported Reserve Balance E25 A4

Explain Variance:

B) Checks to ensure current participant saving balance reasonableness:

Total Savings Deposits Ever Made by Participants Item F12 B1

Minus Total Withdrawals Made byParticipants

Sum of Items: G4 + G10+ G16 + G22 + G28 +G32=

- B2

Equals Calculated Current SavingsBalance

= B3

Compare To: Reported Current SavingsBalance

F61 B4

Explain Variance:

C) Checks to ensure the number of current participant savings accounts open is reasonable

Total Savings Accounts Ever Opened by Participants F9 C1

Minus Total Accounts Ever Closed Sum of: F10 + F11 - C2Equals Calculated Number of Savings

Accounts Currently open= C3

Compare to: Reported Number of SavingsAccounts Currently Open

F60 C4

Explain Variance:




Section I - 2007 AFI Grantee Information Update Form

The AFI Resource Center needs your help to stay in contact with your agency by assisting in updating the AFI grantee database. Pleasereview the information that we currently have in our database about your organization, fill in the necessary blanks, and make adjustmentswhen necessary. There are 9 main categories of contact information. The 9 categories are listed below for your reference. For “State,”

please use the two-letter U.S. Postal Code abbreviation.ITEM 1: GRANTEE ORGANIZATION: This is contact information for the grantee organization.

ITEM 2: GRANT/PROJECT INFORMATION: Please review this information and make changes where necessary.

ITEM 3: MAIN CONTACT - The person(s) who AFI staff should call first if there are questions concerning the grant or overall AFI Project.Usually, this is the person in charge of day-to-day operation of the AFI Project.

ITEM 4: ALTERNATE CONTACT - The person(s) who AFI staff should call if the main contact is not available.

ITEM 5: AGENCY LEADERSHIP - The agency executive director, president, etc. with authority to sign official documentation. This personis usually the signatory on the grant documents.

ITEM 6: DATA CONTACT - The person(s) who compiles the data report for the AFI Annual Report to Congress.

ITEM 7: OTHER CONTACTS - Other staff involved with the management and day-to-day operations of the AFI Project. Use this spaceand attach additional pages to provide as many contacts as appropriate.

ITEM 8: NAMES AND ADDRESSES OF SUB-GRANTEE OR SUB-CONTRACTORS : Instructions : Please provide the names andaddresses of all organizations that are providing AFI IDA services through a sub-grant or sub-contract. This information is helpful for developing a complete listing of all locations where people may enroll and participate in an AFI Project. Please provide this information on

an attached page in the following format:ITEM 9: LISTSERV : Instructions : The AFI Resource Center ListServ is an important tool for alerting grantees and other interested groupsabout important programmatic information and upcoming events, such as new application dates, trainings, and conference calls. Westrongly encourage all key contacts to sign up for this ListServ. If you are uncertain whether you or someone in your organization is signedup, please add their name to the list. We will add them if they are not already on the list.




Section J - Characteristics of AFI Account Holders Making a Matched Withdrawal in the Past Year

This section asks about the characteristics of AFI IDA Account Holders making a matched withdrawal, which we define as those who have made at leastone matched withdrawal between October 1, 2006 and September 30, 2007. AFI Account Holders in this section are referred to as ‘Asset Purchasers’.If data is known for some, but not all AFI Asset Purchasers, please provide the number of unknown in the “unknown” field.

2007Form


Answers/Units of


NUMBER OF AFI IDA ACCOUNT HOLDERS MAKING A MATCHED WITHDRAWALDid the grantee collect data on this topic?

Yes or No Not required

J.2 NUMBER OF AFI IDA ACCOUNT HOLDERS MAKING A MATCHED WITHDRAWALPlease indicate the number of AFI IDA Account Holders who have made at least one matchedwithdrawal between October 1, 2006 and September 30, 2007.

Not required

GENDER OF AFI ASSET PURCHASERSPlease indicate the number of AFI Asset Purchasers in each of the following demographiccategories. (The sum of these should be the number reported in question J.2.)Did the grantee collect data on this topic? Yes or No Not required

J.4 Male Not requiredJ.5 Female Not requiredJ.6 Unknown Not required

RACE/ETHNICITY OF AFI ASSET PURCHASERSPlease indicate the number of AFI Asset Purchasers in each of the following demographiccategories. (The sum of these should be the number reported in question J.2.)

For any “Other” response, please provide details about these individuals in the text box.Did the grantee collect data on this topic? Yes or No Not required

J.8 African American Not requiredJ.9 Asian American / Pacific Islander Not requiredJ.10 Caucasian Not requiredJ.11 Hispanic (Please keep in mind that “Hispanic” is an exclusive category that takes precedence

over all other categories.)Not required

J.12 Native American Not requiredJ.13 Other (please specify number and provide details in text box) The data form will

have a text box withroom for a completedescription.

Not required

J.14 Number of Unknown Not required




2007Form


Answers/Units of


AGE (at time of enrollment) OF AFI ASSET PURCHASERSPlease indicate the number of AFI Asset Purchasers in each of the following demographiccategories. (The sum of these should be the number reported in question J.2.)Did the grantee collect data on this topic? Yes or No Not required

J.16 19 years and under Not requiredJ.17 20-29 years Not requiredJ.18 30-39 years Not requiredJ.19 40-49 years Not requiredJ.20 50 years and older Not requiredJ.21 Unknown Not required

MARITAL STATUS (at time of enrollment) OF AFI ASSET PURCHASERSPlease indicate the number of AFI Asset Purchasers in each of the following demographiccategories. (The sum of these should be the number reported in question J.2.)

For any “Other” response, please provide details about these individuals in the text box.Did the grantee collect data on this topic? Yes or No Not required

J.23 Single, never married Not requiredJ.24 Married Not requiredJ.25 Separated Not requiredJ.26 Divorced Not requiredJ.27 Widowed Not requiredJ.28 Other (please specify number and provide details in the text box) The data form will

have a text box withroom for a complete

description.

Not required

J.29 Unknown Not requiredEDUCATIONAL ATTAINMENT (at time of enrollment) OF AFI ASSET PURCHASERSPlease indicate the number of AFI Asset Purchasers who reported the following educationalattainment levels at time of enrollment in the AFI Project. (The sum of these should be thenumber reported in question J.2.)Did the grantee collect data on this topic? Yes or No Not required

J.31 Completed grades K-5 Not requiredJ.32 Completed grades 6-8 Not requiredJ.33 Completed grades 9-11 Not requiredJ.34 High School Diploma Not required




2007Form


Answers/Units of


J.35 Vocational School Diploma / Degree Not requiredJ.36 Some College Not required

J.37 AA Degree / Graduated two-year college Not requiredJ.38 BA/BS Degree / Graduated four-year college Not requiredJ.39 Some Graduate School / Attended Graduate School Not requiredJ.40 MA/MS, etc. Graduate Degree(s) Not requiredJ.41 Unknown Not required

LOCATION TYPE (at time of enrollment) OF AFI ASSET PURCHASERSPlease indicate the number of AFI Asset Purchasers who reported their primary address as oneof the following geographic categories. (The sum of these should be the number reported inquestion J.2.)

J.42 Did the grantee collect data on this topic? Yes or No Not requiredJ.43 Major urban area (metropolitan statistical area with population greater than 1,000,000) Not required

J.44 Minor urban area (metropolitan statistical area with population less than 1,000,000) Not requiredJ.45 Rural/Remote Area Not requiredJ.46 Unknown Not required

HOUSEHOLD COMPOSITION (at time of enrollment) OF AFI ASSET PURCHASERSPlease indicate the number of AFI Asset Purchasers who reported that the following categoriesof children (age 17 and younger) lived in their household at time of enrollment. (The sum of these should be the number reported in question J.1.)Did the grantee collect data on this topic? Yes or No Not required

J.48 No children Not requiredJ.49 One child Not requiredJ.50 Two children Not required

J.51 Three children Not requiredJ.52 Four children Not requiredJ.53 Five children Not requiredJ.54 Six or more children Not requiredJ.55 Unknown Not required

EARNED INCOME (at time of enrollment) OF AFI ASSET PURCHASERSPlease indicate the number of AFI Asset Purchasers who reported earned income at thefollowing levels at the time of enrollment. (The sum of these should be the number reported inquestion J.2.)Did the grantee collect data on this topic? Yes or No Not required


health and human services: 2007 afi data report guide

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